Cultivating Courage for Birth: Induction
Many women in the United States end up getting induced. There are various reasons for an induction; some are evidenced-based and others are provider’s preference. If your doctor or midwife is recommending an induction, it is important to understand why they are making this recommendation. You want to have a clear understanding of what the induction may look like.
The truth is some inductions are medically necessary, and some inductions are not. Each doctor or midwife team has different ideas around induction.
The foundation of Lamaze is the 6 Healthy Birth Practices, and the first Healthy Birth Practice is to allow labor to begin on its own, unless there is a true medical indication for an induction. Unequivocally, labor has best outcomes when it is allowed to start spontaneously, without induction.
An induction changes birth from a purely physiological event to a medical event.
I have supported hundreds of inductions. I have supported hundreds of beautifully empowered inductions.
The Key to an Empowered Induction
First, you fully understand the reason for your induction. Second, you are the one making all of the medical decisions about your induction. Third, you are using both natural coping tools and medical tools to help your labor progress.
The first questions to ask when considering an induction are: Will the baby’s health be better inside or outside of the womb? Is the mom’s health going to improve with the baby inside or outside of the womb?
Questions to Ask Your Doctor
It’s important to know to what extent your doctor or midwife is comfortable going past your due date. This answer may change as your pregnancy continues and as things shift. However, it is good to see if your doctor/midwife feels comfortable with letting low-risk mothers go to a full 42 weeks in their pregnancy. Remember: a full-term pregnancy is anywhere from 37-42 weeks, and most first-time mothers have their baby after 40 weeks.
There are many factors that affect your doctor’s comfort level with going past your due date: your age, your use of fertility treatments, your pre-existing health issues, the size of your baby, and your current health all play a part.
Every decision in labor needs to be an informed medical decision. The truth is your doctor cannot force you to get induced; they can explain risks and benefits, but you make the decision to move forward or not.
Some doctors have a significantly higher induction rate than others. It is important to discuss your doctor's induction policy early on in pregnancy, so if you do not feel comfortable with their values you have plenty of time to find a doctor/midwife who is a better fit for you. This is especially important if you are of advanced maternal age or you are having an IVF pregnancy. In both scenarios, some medical practices enforce induction policies, regardless of the individual’s health.
If you go past your due date, your practice may do a non-stress test or a biophysical ultrasound. Both of these exams help your provider confirm that your baby is thriving on the inside.
Questions to Think About
What medications will they use for your induction?
Does your hospital have wireless monitors?
Will your hospital feel comfortable with you eating and drinking in labor?
Things to Consider
Hospital fatigue is real! The hardest part of an induction is often just being at the hospital for your entire labor.
Once any medication is introduced into your system, you must be continually monitored. However, it is important to remember that even though you have to be continuously monitored it does not mean that you have to stay in bed. You can still change positions and move in a way that feels intuitive and comfortable. Some hospitals have wireless monitors, which make movement easier. Still, if your hospital does not offer this, you can move into almost every position, but still closer to the bed.
Just because you end up with an induction doesn’t mean you have to use an epidural. You may want to, but these are separate decisions.
The first part of an induction process is usually long for a first time mom. You can be at the hospital for one or two days before labor even begins. The first part of an induction process is all about ripening the cervix, preparing it for labor before contractions start. This is often uneventful. So, you have to be able to rest, relax, and nourish yourself.
Journal Prompts
What makes you nervous about an induction? What would help eliminate this fear?
What would an empowered induction look like for you?
What makes you feel good about an induction?
Do you trust your medical team?
How can you help yourself feel safe in the hospital?
Do you have a clear understanding of what the process will look like?
Which items do you want to bring to the hospital to help you feel safe and comfortable?
Important
I think one of the most important parts of an induction is that your medical team is not trying to make things progress too fast. The goal is to allow your own oxytocin to be released after the introduction of medication. If your contractions are getting stronger and closer together, and your doctor offers to introduce another medication or tool, ask them to give you more time.
Medications Used for an Induction
Prostaglandins
Prostaglandins are hormones that soften and ripen the cervix, making it more favorable for labor to begin. Prostaglandin medications may be administered as a gel, tablet, or vaginal suppository. Examples include dinoprostone (Cervidil, Prepidil) and misoprostol (Cytotec).
Pitocin
Pitocin is a synthetic form of the hormone oxytocin, which is produced naturally by the body. Pitocin stimulates uterine contractions and can be administered through an IV drip.
Membrane Stripping or Sweeping
While not a medication per se, membrane stripping or sweeping is a procedure that separates the amniotic sac from the uterine wall. This separation releases prostaglandins and encourages labor to begin.
Artificial Rupture of Membranes (Amniotomy)
An amniotomy involves intentionally breaking the amniotic sac to release amniotic fluid, which may help stimulate contractions and initiate labor. It is important that your provider does not use this tool till your cervix is at least 6 centimeters.
Foley Bulb
A Foley bulb is a balloon inserted into the cervix and then inflated with sterile water or saline solution. The pressure exerted by the inflated balloon helps to mechanically dilate and soften the cervix, promoting the onset of labor contractions. Once the cervix has sufficiently dilated and labor has begun, the Foley bulb is typically removed.